Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | ME119712 | FL |
Y | 207VX0000X | Obstetrician | ME119712 | FL |
NPI | 1306936893 |
---|---|
Provider Name | Katrina Davis |
First Address | Rockledge, FL 32955-3608 |
Second Address | Sarasota, FL 34239-6304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 04/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3850497 | (05) | FL |
G76650 | (02) |